|
IV Product
|
Oral Conversion Product
|
Comments
|
Infectious Disease Agents |
| Acyclovir |
Acyclovir
Herpes Simplex: 200 mg po q4h (5x/d)
Herpes Zoster acute treatment: 800 mg po q4h (5x/d)
Varicella Zoster: 800 mg po qid x 5d
Valacyclovir
Herpes Zoster: 1 g po tid X 7 days
|
Valacyclovir is rapidly and nearly completely converted to Acyclovir |
| Ampicillin |
Ampicillin 250-500 mg po qid or Amoxicillin 250-500 mg tid |
|
| Ampicillin-sublactam |
Augmentin 250-500 po q8h |
|
| Azithromycin |
250 mg po qd for 5-10 days |
|
| Cefazolin |
Cefadroxil 500 mg po q12h, Cephalexin 500 mg po q6h, or Cefaclor 500 mg po
q8h |
Cefaclor provides gram (-) coverage similar to cefazolin that is not provided
by cefadroxil or cephalexin |
| Cefepime |
Ceftibuten 400 mg po qd |
The spectrum of ceftibuten closely approximates the spectrum of cefepime except
for Ps. aeruginosa |
| Cefotaxime |
Cefpodoxime 100-200 mg po q12h, Cefixime 400 mg po qd, or Ceftibuten 400 mg
po qd |
Ceftibuten may provide additional gram (-) coverage not provided by cefpodoxime
or cefixime |
| Cefotetan |
Cefuroxime 250-500 mg bid, Cefixime 400 mg po qd |
The spectrum of cefuroxime, cefixime, and ceftibuten closely approximates the
gram (+) and gram (-) spectrums of cefotetan. Metronidazole covers the anerobic organisms not covered by the cephalosporins |
| Cefoxitin |
Cefuroxime 250-500 mg bid, Cefixime 400 mg po qd |
The spectrum of cefuroxime, cefixime, and ceftibuten closely approximates the
gram (+) and gram (-) spectrums of cefoxitin. Metronidazole covers the anerobic organisms not covered by the cephalosporins |
| Ceftizoxime |
Cefixime 400 mg po qd |
Ceftibuten may provide additional gram (-) coverage not provided by cefpodoxime
or cefixime |
| Ceftriaxone |
Cefpodoxime 100-200 mg po q12h, Cefixime 400 mg po qd |
Ceftibuten may provide additional gram (-) coverage not provided by cefpodoxime
or cefixime |
| Cefuroxime |
Cefuroxime 250-500 mg q12h |
|
| Chloramphenicol |
Convert IV dose to equivalent oral dose |
The oral formulation has increased bioavailability compared to IV formulation
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed |
| Ciprofloxacin |
250-750 mg po q12h |
|
| Clindamycin |
150-450 mg po q6h |
|
| Cimetidine |
300 mg po qid, 400 mg po bid, or 800 mg po qhs |
|
| Doxycycline |
50-100 mg po bid |
|
| Erythromycin |
Tab: 250 mg po q6h, 333 mg po q8h, 500 mg po q12h
Susp: 400 mg po q6h, 800 mg po q12h
Legionnaire’s disease: 250-1000 mg po qid
|
Multiple erythromycin salts and products are available. Refer to hospital formulary
for available products. |
| Fluconazole |
50-400 mg po qd |
|
| Ganciclovir |
CMV retinitis maintenance dosing: 1000 mg po tid with food or 500 mg po 6X/d
(q3h while awake) with food |
|
| Isoniazid |
300 mg po qd |
|
| Levofloxacin |
250-500 mg po qd |
|
| Nafcillin |
Dicloxacillin 250-500 mg po qid |
|
| Metronidazole |
250-500 mg po tid |
|
| Ofloxacin |
200-400 mg po bid |
|
| Oxacillin |
Oxacillin 250-1000 mg po q4-6h or dicloxacillin 250-500 mg po qid |
|
| Penicillin G |
Penicillin VK 250-500 mg po qid |
|
| Rifampin |
300-600 mg po qd |
|
| Trimethoprim-sulfamethoxazole (TMP-SMX) |
1 Septra or 1 Septra DS tab (or equivalent susp volume) po q12h |
|
Cardiology Agents |
| Digoxin maintenance dose |
Convert IV dose to equivalent oral dose |
Oral dose approximately equal to IV dose
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed |
| Diltiazem continuous infusion |
3 mg/h = Diltiazem CD 120 mg po qd
5 mg/h = Diltiazem CD 180 mg po qd
7 mg/h = Diltiazem CD 240 mg po qd
11 mg/h = Diltiazem CD 300 mg po qd
|
After constant IV infusion , diltiazem exhibits nonlinear pharmacokinetics
over the infusion range of 5-13 mg/h
The oral conversions are expected to produce approximately equivalent steady-state plasma concentrations to the
IV dose |
| Enalaprilat |
CrCl > 30 ml/min: 5 mg po qd
CrCl < 30 ml/min: 2.5 mg po qd |
|
| Hydralazine |
10-50 mg po qid |
|
| Labetalol |
100-400 mg po bid |
|
| Methyldopa |
250-500 mg po bid-qid |
|
| Metoprolol |
Tab: 25-200 mg po bid
SR-tab: 50-100 mg po qd |
|
| Nicardipine continuous infusion |
0.5 mg/h = 20 mg po q8h
1.2 mg/h = 30 mg po q8h
2.2 mg/h = 40 mg po q8h
|
|
| Procainamide continuous infusion |
1. Multiply the hourly procainamide infusion rate (mg/h) by 24 to determine
the total daily dose
2. Divide the total daily procainamide dose by the number of dosing intervals
appropriate for the oral procainamide product selected (q12h: 2; q6h: 4; q3h: 8)
3. Select the closest available dosage strength of the product selected
4. Stop the IV infusion with the first administered oral dose
5. Monitor procainamide concentration 24-48 hours after switching to oral
product
|
Monitor serum concentrations after conversion to oral therapy and adjust oral
dose as needed |
| Quinidine gluconate |
1. Multiply the hourly quinidine gluconate infusion rate (mg/h) by 24 to
determine the total daily dose
2. Multiply the total daily quinidine gluconate dose by 1.4 to determine
the equivalent oral quinidine gluconate dose
2. Divide the total daily dose by the number of dosing intervals appropriate
for the oral quinidine gluconate product selected (q6h: 4; q8h: 3)
3. Select the closest available dosage strength of the product selected
4. Stop the IV infusion with the first administered oral dose
5. Monitor quinidine concentration 24-48 hours after switching to oral product
|
The bioavailability of oral quinidine gluconate is approximately 70%
Quinidine gluconate delivers 62% quinidine alkaloid
Quinidine gluconate is available as a 324-mg sustained release tablet. This
formulation may be broken in half for administration
Monitor serum concentrations after conversion to oral therapy and adjust
oral dose as needed
|
| Verapamil |
Tab: 40-120 mg po q8h
SR-tab/cap: 120-240 mg po qd
|
|
Central Nervous System Agents |
| Midazolam |
0.5-1 mg/kg po |
|
| Ketamine |
10 mg/kg po |
|
| Ketorolac |
10 mg po qid |
Maximum combined duration of therapy is 5 days |
| Phenobarbital |
Oral dose equals IV dose |
Monitor serum concentrations after conversion to oral therapy and adjust oral
dose as needed |
| Fosphenytoin |
Switch to Dilantin brand of phenytoin at same total daily dose |
Monitor serum concentrations after conversion to oral therapy and adjust oral
dose as needed |
| Phenytoin |
Convert IV dose to equivalent oral dose |
Oral dose approximately equal to IV dose
Only Dilantin brand of phenytoin may be given as a single daily dose
Monitor serum concentrations after conversion to oral therapy and adjust
oral dose as needed
|
Endocrine |
| Levothyroxine |
Oral dose equals 1.33 times IV dose |
|
| Hydrocortisone |
Oral dose equals IV dose |
|
| Methylprednisolone |
Oral dose equals IV dose |
Oral powder or elixir must be diluted in at least 120 ml of fluid before administration
to prevent osmotic diarrhea |
Gastroenterology |
| Famotidine |
10-20 mg po bid or 40 mg po qhs |
|
| Ranitidine |
150 mg po bid or 300 mg po qd |
|
| Metoclopramide |
5-15 mg po qid |
|
| Granisetron |
1 mg po bid, with the first dose given up to 1h before highly emetogenic chemotherapy,
and the 2nd dose given 12h after the first dose |
|
| Ondansetron |
Administer first dose (4-8 mg) 30 minutes before start of chemotherapy, with
subsequent doses 4h and 8h after first dose, then 4-8 mg po tid for 1-2d after completion of chemotherapy |
|
Immunosuppressive Agents |
| Cyclosporine |
Oral dose equals 3X IV dose |
Monitor serum concentrations after conversion to oral therapy and adjust oral
dose as needed |
The patient, degree of organ impairment, severity of infection or disease
state, and duration of IV therapy at time of switch are important in determining the most appropriate oral dose.
Many hospitals with switch programs have predetermined the most appropriate oral dose for the switch. |
